Fundamentals ATI Study Guide Flashcards

Questions and Answers

What health risks are young adults (20 to 35 years) at risk for?

Substance abuse

Periodontal disease

Unplanned pregnancy

All of the above (correct)

For hypoglycemia, take _____ g of readily absorbable carbs.

10 to 20

What should be avoided when providing foot care to clients with diabetes mellitus?

Over-the-counter products that contain alcohol or strong chemicals

Which position is recommended for both lower lobes during postural drainage?

Supine in Trendelenburg Signup and view all the answers

What does a red appearance of a wound indicate?

Healthy regeneration of tissue Signup and view all the answers

Readings less than 90% for oxygen saturation indicate normal respiratory status.

False Signup and view all the answers

Which class of medications should not be mixed with large amounts of food when administering enterally?

Analgesics Signup and view all the answers

Match the unexpected findings with their descriptions in NG intubation and enteral feedings:

Gastric residual exceeding 250 mL for two consecutive assessments = High residual volume Diarrhea three or more times in a 24-hour period = Frequent bowel movements Nausea or vomiting = Gastrointestinal distress Aspiration of formula = Inhalation of feeding formula Signup and view all the answers

What should be established to help prevent skin breakdown?

Toileting schedule Signup and view all the answers

When teaching an older adult about home safety, ensure there are _____ near the toilet and shower.

grab bars Signup and view all the answers

What should be monitored to prevent aspiration during meals after a stroke?

Client's ability to tuck their chin when swallowing Signup and view all the answers

Healthcare team members should check for a latex allergy before beginning any task or procedure.

True Signup and view all the answers

Which of the following tasks can be delegated to assistive personnel? (Select all that apply)

Specimen collection Signup and view all the answers

What should be included in discharge planning for a client with diabetes mellitus? (Select all that apply)

Schedule teaching sessions at optimal times Signup and view all the answers

What actions should a nurse take when a client falls? (Select all that apply)

Remove hazards for falls Signup and view all the answers

When evaluating a client's use of a walker, which guidelines should be followed? (Select all that apply)

Advance the walker before taking steps Signup and view all the answers

Which are appropriate methods for maintaining an indwelling urinary catheter? (Select all that apply)

Ensure bag is lower than the bladder Signup and view all the answers

What actions should be taken when assisting a client to use a fracture pan? (Select all that apply)

Raise the head of the bed 30 degrees Signup and view all the answers

When calculating fluid intake, which conversions are correct? (Select all that apply)

1 oz = 30 mL Signup and view all the answers

What therapeutic uses are associated with herbal supplements? (Select all that apply)

Ginkgo biloba = Dementia support Signup and view all the answers

What key points must be considered when completing an informed consent document? (Select all that apply)

Written consent is mandatory for invasive procedures Signup and view all the answers

What considerations should be made when bathing clients who have dementia? (Select all that apply)

Bathtime can cause stress and disorientation Signup and view all the answers

What changes occur in urinary function with aging that increases the risk for urinary infections? (Select all that apply)

Increased nocturia Signup and view all the answers

What guidelines should be followed regarding the appropriate use of crutches? (Select all that apply)

Position crutches on the unaffected side Signup and view all the answers

Which laboratory values should be reported in airway management? (Select all that apply)

Cyanosis Signup and view all the answers

What essential practices should be followed when caring for an artificial eye? (Select all that apply)

Maintain health through a balanced diet Signup and view all the answers

What instructions should be given for using an incentive spirometer? (Select all that apply)

Exhale normally after using the device Signup and view all the answers

What are the proper techniques for dressing a wound? (Select all that apply)

Use gentle friction Signup and view all the answers

What do the abbreviations SOAP and PIE stand for in nursing documentation? (Select all that apply)

PIE = Problem, Intervention, Evaluation Signup and view all the answers

What recommendations should be made for home safety for older adult clients? (Select all that apply)

Install grab bars in bathrooms Signup and view all the answers

What precautions should be implemented for infection control? (Select all that apply)

Using gloves and gowns for contact precautions Signup and view all the answers

What alternatives to restraints ensure client safety? (Select all that apply)

Electronic devices for monitoring Signup and view all the answers

What techniques can prevent plantar flexion in immobile clients? (Select all that apply)

Teach range of motion exercises Signup and view all the answers

What considerations should be made when using a fracture pan? (Select all that apply)

Provide skin care to the perianal area Signup and view all the answers

What assessment findings indicate extracellular fluid volume deficit? (Select all that apply)

Decreased urine output Signup and view all the answers

What are possible manifestations of a mild allergic reaction? (Select all that apply)

Rashes Signup and view all the answers

When mixing insulin, which steps are critical? (Select all that apply)

Draw the short-acting insulin first Signup and view all the answers

What supplies should be at the bedside for a client with a tracheostomy? (Select all that apply)

Emergency call system Signup and view all the answers

What practices should be followed during nasotracheal suctioning? (Select all that apply)

Encourage the client to cough without suction Signup and view all the answers

What should be assessed for wound healing? (Select all that apply)

Length and depth of the wound Signup and view all the answers

What steps are involved in addressing ethical dilemmas? (Select all that apply)

Gather relevant information Signup and view all the answers

What constitutes an intentional tort? (Select all that apply)

Battery includes wrongful physical contact Signup and view all the answers

What actions should be taken when handling defective equipment? (Select all that apply)

Assess risks associated with equipment Signup and view all the answers

What are the required precautions for infection control? (Select all that apply)

Private rooms for airborne infections Signup and view all the answers

Study Notes

Delegation and Supervision: Tasks for Assistive Personnel

Tasks suitable for delegation include specimen collection, routine vital signs (not initial or post-op), assisting with activities of daily living (ADLs), and care for chronic conditions.
Medications should never be delegated to assistive personnel.

Client Education: Discharge Planning for Diabetes Mellitus

Establish mutually agreeable goals between the client and healthcare provider.
Tailor teaching methods to the client's preferred learning style and age.
Foster independence by encouraging active participation in their care.
Optimal scheduling of discharge teaching sessions enhances learning retention.

Client Safety: Actions When a Client Falls

Document the fall clearly without subjective comments.
Avoid attempting to catch the client by pulling on limbs; allow them to slide down.
Ensure environmental safety by keeping beds low, removing clutter, and providing non-slip socks.

Mobility and Immobility: Walker Use Evaluation

Instruct clients to lean slightly forward while using the walker.
Ensure the walker is advanced before taking steps, and the weaker leg steps first.
Keep the back straight to maintain posture when using the walker.

Urinary Elimination: Indwelling Catheter Maintenance

Clean the catheter site with soap and water, and minimize the time the catheter is in place.
Empty the collection bag at least every 8 hours and clean the port before obtaining samples.
Position the catheter bag lower than the bladder to prevent backflow.

Bowel Elimination: Using a Fracture Pan

Schedule regular times for bowel movements.
Elevate the head of the bed to at least 30 degrees to facilitate use of the fracture pan.
Avoid leaving the client lying flat; assist with rolling side to side if necessary.

Nutrition and Oral Hydration: Fluid Intake Calculation

Conversion metrics: 1 oz = 30 mL, 1 cup = 240 mL, 1 tsp = 5 mL, 1 tbsp = 15 mL.
Total fluid intake should be calculated in mL for accurate assessment.

Complementary and Alternative Therapies: Herbal Supplements Use

Echinacea may boost immune function.
Garlic can aid in managing cardiovascular disease and hypertension.
Ginger has properties for anti-nausea and anti-inflammatory effects.
Ginkgo biloba is potentially beneficial for dementia and circulation issues.
Valerian is known for its anxiolytic and sedative properties.

Informed consent is necessary for invasive procedures; must include written consent.
Understanding of the information is essential; a trained medical interpreter may be needed for language barriers.
Legal guardians or individuals with durable power of attorney may consent on behalf of others.

Hygiene: Bathing Clients with Dementia

Bathe clients only when health issues necessitate assistance.
Be cautious of producing disorientation in clients with dementia during bathing.
Adapt techniques to account for drier and thinner skin in older adults.

Urinary Elimination: Aging Effects on UTIs

Aging leads to decreased bladder efficiency and muscle tone.
Older adults experience increased frequency, residual urine risk, and nocturia.

Mobility and Immobility: Crutches Use Guidelines

Crutches should not be altered after fitting; follow the prescribed gait.
Support body weight at hand grips with elbows flexed at approximately 30 degrees.
Maintain a safe distance from the body to prevent irritation in the axillae.

Fluid Imbalances: Hyperosmolar Imbalance

Hyperosmolar imbalance refers to dehydration, characterized by water loss without losing electrolytes.
Signs include elevated hematocrit, serum electrolytes, and urine specific gravity.
Compensatory mechanisms include increased thirst and hormonal responses.

Nasogastric Intubation: Reporting Unexpected Findings

Assess drainage color for abnormalities; dark or blood-streaked colors should be reported.
Monitor for occlusion, discomfort, increased gastric residual, and changes in bowel patterns.

Glucose Monitoring: Capillary Blood Sample Collection

Outer fingertip edge is the preferred site; alternative sites include earlobes and palms.
Warm the site to improve circulation and clean the area before sampling.
Discard the first drop of blood, then use subsequent drops for testing.

Airway Management: Signs to Report

Early signs include tachypnea, tachycardia, restlessness, and anxiety.
Late signs consist of stupor, cyanosis, bradycardia, and hypotension.

Sensory Perception: Care for an Artificial Eye

Maintain hand hygiene before and after touching the eye.
Encourage a diet rich in antioxidants and manage chronic health conditions.

Airway Management: Using Incentive Spirometry

Incentive spirometry helps monitor breath intake; seal lips around the mouthpiece for effectiveness.
Inhale deeply, hold for three seconds, then exhale normally.

Pressure Ulcers: Dressing for Pressure Ulcers

Clean wounds from less contaminated to more contaminated areas, documenting all relevant information.
Use appropriate products and techniques that minimize fiber shedding.

Information Technology: Common Abbreviations

Familiarize with SOAP (Subjective, Objective, Assessment, Plan), PIE (Problem, Intervention, Evaluation), and DAR (Data, Action, Response).

Home Safety: Discharge Teaching for Older Adults

Remove tripping hazards and install grab bars.
Suggest using non-slip mats and ensure the safe storage of electrical cords.

Infection Control: Isolation Precautions

Implement standard precautions for all body fluids except sweat; includes hand hygiene.
Transmission-based precautions include airborne, droplet, contact, and protective measures for immunocompromised patients.

Client Safety: Alternatives to Restraints

Promote environmental orientation, provide diversional activities, and encourage family involvement.
Explain restraint use to clients, emphasizing temporary safety measures.

Mobility and Immobility: Preventing Plantar Flexion

Teach range of motion exercises; encourage active participation in daily activities.
Continuous passive motion devices may be utilized based on client needs.

Fluid Imbalances: Assessment of Extracellular Fluid Volume Deficit

Monitor vital signs for tachycardia and hypotension; watch for confusion or weakness.
Neurological and gastrointestinal symptoms may indicate fluid deficit.

Adverse Effects and Contraindications: Mild Allergic Reaction Manifestations

Recognize allergic reactions, which vary in severity from mild to severe.
Document client allergies and medical history before medication administration.

Diabetes Mellitus: Mixing Insulin

Mix short-acting insulin first with longer-acting insulin to prevent cross-contamination.
Special care should be taken with suspensions and avoid administering cloudy insulins.

Airway Management: Tracheostomy Care

Maintain emergency supplies and communication tools readily available at the bedside.
Ensure adequate humidification and hydration to prevent secretions from blocking the airway.

Airway Management: Nasotracheal Suctioning Technique

Use proper personal protective equipment and position clients to facilitate suctioning.
Monitor vital signs and limit suction duration to minimize discomfort.

Pressure Ulcers: Assessment of Wound Healing

Observe color of wounds, noting signs of healthy regeneration versus infection or necrosis.
Assess and document the wound characteristics meticulously.

Ethical Responsibilities: Priority Client for Interprofessional Team Discussion

Identify whether an issue constitutes an ethical dilemma and gather relevant information.
Reflect on values, analyze options, and select a course of action in line with ethical principles.

Legal Responsibilities: Intentional Tort Identification

Recognize the definitions of assault, battery, and false imprisonment in a healthcare context.
Understand the legal implications of each type of intentional tort concerning patient rights.

Client Safety: Handling Defective Equipment

Evaluate safety in environments; document incidents and encourage client communication about safety concerns.
Use protocols for dangerous scenarios and ensure proper equipment use after training.### Positioning Techniques for Respiratory Aid
Left lower limb in Trendelenburg on left side position
Left upper limb anteriorly while supine with head elevation; left upper limb posteriorly on right side with a pillow
Left lower limb laterally positioned on right side in Trendelenburg
Both lower lobes laterally on right side in Trendelenburg
Both lower lobes anteriorly while supine in Trendelenburg; posteriorly in prone position in Trendelenburg

Pressure Ulcers and Wound Management

Wound appearance:
- Red indicates healthy tissue regeneration
- Yellow signifies purulent drainage/slough
- Black indicates eschar that obstructs healing
Document wound size and characteristics using a clock face, noting length, width, depth, and any undermining or sinus tracts
RYB color code for wound care:
- Red: cover
- Yellow: clean
- Black: debride
Closed wounds should have well-approximated skin edges

Assessing Exudate

Monitor amount, odor, consistency, and color during healing phases
Common types of exudate:
- Serous: clear or slightly yellow, watery
- Sanguineous: serum mixed with RBCs
- Serosanguineous: serum and blood
- Purulent: yellow or brown indicative of infection; foul odor present
- Purosanguineous: mixture of pus and blood
Accurate drainage measurement by weighing dressings (1 g = 1 mL)

Monitoring Oxygen Saturation

Noninvasive measurement of blood oxygen levels to assess respiratory status
Readings under 90% indicate hypoxemia, with potential lower values in older adults and clients with dark skin
Factors impacting readings: hypothermia, poor blood flow, excessive light, low hemoglobin levels, jaundice, movement, edema, and nail polish

Intravenous Therapy: Catheter Insertion Procedure

Application of clean tourniquet above insertion site to promote vein visibility
Vein selection through visualization methods, gravity, fist clenching, and friction
Cleaning the area, retie tourniquet, and skin tautness before insertion
Insert catheter at a 10-30 degree angle with bevel facing up; advance until blood flashback is seen
Stabilize catheter upon insertion, remove tourniquet, apply pressure and activate safety device after needle removal
Secure with dressing and label post-insertion

Enteral Medication Administration

Contraindications include vomiting, decreased GI motility, lack of gag reflex, swallowing difficulties, and lowered consciousness level
Position client at a 90-degree angle for administration
Administer irritating medications with small food amounts, but avoid large mixtures
Prefer liquid medication forms, and generally administer on an empty stomach

Unexpected Findings during NG Intubation and Enteral Feedings

Gastric residual over 250mL on two consecutive checks
Diarrhea reported three or more times in 24 hours
Signs of nausea, vomiting, or formula aspiration
Skin irritation around the tubing site

Preventing Thrombus Formation

Use anti-embolic stockings and proper positioning to minimize compression
Promote range-of-motion exercises including ankle pumps and knee flexion
Ensure increased fluid intake and frequent position changes
Avoid pressure or massage over thrombi to prevent dislodgement

Preventing Skin Breakdown

Establish a regular toileting schedule
Increase daytime fluid intake and limit before bedtime
Provide incontinence garments and care
Avoid indwelling catheters to minimize risk

Home Safety for Older Adults

Remove potential trip hazards and place electrical cords securely
Monitor gait and balance for safety
Ensure steps and sidewalks are well-maintained
Install grab bars in relevant areas like toilets and showers; use non-skid mats and shower chairs
Maintain good lighting both inside and outside

Nutrition and Oral Hydration Post-Stroke

Position client properly in Fowler's position or a chair
Support upper body and encourage chin-tucking while swallowing
Avoid straws and monitor for signs of aspiration and dysphagia
Maintain the semi-Fowler's position post-meals for an hour and facilitate oral hygiene thereafter

Medical Asepsis with Latex Allergy Considerations

Always check for latex allergies prior to procedures
Use latex-free equipment and gloves if allergies are present
Ensure patient wears an allergy identification band for safety purposes

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers essential topics from the RM Fundamentals 8.0 study guide, focusing on delegation, supervision, and client education in healthcare settings. Key concepts include tasks suitable for assistive personnel and discharge planning for diabetes mellitus. Prepare effectively for your nursing exams with these flashcards.